Provider Demographics
NPI:1275938573
Name:CHURCH, LESLIE
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:CHURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19375-0259
Mailing Address - Country:US
Mailing Address - Phone:484-716-0398
Mailing Address - Fax:
Practice Address - Street 1:272 LINE RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2232
Practice Address - Country:US
Practice Address - Phone:484-716-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst